Abstracts

Rationale: Rapid Response electroencephalograms (rrEEGs) are often deployed by hospital personnel to help distinguish nonconvulsive status epilepticus from other causes of impaired consciousness when continuous EEG (cEEG) is not immediately available. We sought to determine if performing rrEEG to screen for seizures alters the management of antiseizure medications (ASM) when seizures are detected.

Methods: We screened EEG findings and clinical data of all patients who had rrEEG using the Ceribell^® EEG system at Montefiore Medical Center from 08/2019 to 02/2021. Patients who had a seizure during rrEEG and/or during subsequent cEEG which was placed within the following 24 hours were included in this study. Patients who did not have a seizure on either rrEEG or cEEG were excluded, as were the patients without subsequent cEEG. We analyzed the types and dosages of ASMs administered to patients in the 24 hours prior to rrEEG placement through the first 24 hours of subsequent cEEG recording.

Results: A total of 547 patients at our institution had rrEEG during the study period. Fifty patients (9.1% of 547) were included in this study as they had at least one seizure on either rrEEG alone (33/50 = 66%), both rrEEG and cEEG (6/50 = 12%), or only on subsequent cEEG (11/50 = 22%). The median age was 60.5 years and 42% were female. Of these 50 patients, 12% had cardiac arrest/anoxic or hypoxic brain injury, 36% had other acute intracranial lesions, and 28% had a prior history of epilepsy. The vast majority (92%) had altered mental status, and 42% had motor manifestations suggestive of seizures. The median time lapse between rrEEG disconnection and cEEG placement was 5 hours. 70% of patients had focal seizures on rrEEG and 24% on cEEG. By contrast, 10% had generalized seizures on rrEEG and 8% on cEEG. Prior to rrEEG being connected, 77% received new benzodiazepines and 56% received new or higher doses of conventional ASM. A total of 39 patients had seizures on rrEEG, and 97% of them had an increase in their ASM during the rrEEG or in the interval until cEEG was connected. The majority of these patients (84%) did not have additional seizures on subsequent cEEG. The median duration of rrEEG, approximately 4 hours, was the same for patients who had seizures during the rrEEG vs. only on the following cEEG. For some patients with seizures on rrEEG alone, the rrEEG study duration was extended for up to 6-12 hours to facilitate seizure control.

Conclusions: Treatment was escalated in 97% of patients in whom seizures were identified on rrEEG, leading to seizure control in 84%. Using rrEEG assists with early pharmacological management of patients in whom seizures are suspected. 

Funding: None